Colorectal Cancer Testing and Screening: Why They Matter

Colorectal cancer is a growing health concern worldwide and the Philippines is no exception. Despite the significant strides made in medical technology and healthcare services, colorectal cancer continues to pose a serious threat. The key to combating this disease lies in early detection through routine colorectal cancer screening procedures.

What is Colorectal Cancer?

Colorectal cancer, often referred to as bowel or colon cancer, is a type of cancer that begins in the colon or rectum. It typically develops from abnormal growths, known as polyps, in the lining of the large intestine. Over time, these polyps can transform into cancerous cells, posing health risks and requiring timely detection and intervention.

Colorectal cancer is the 3rd most common cancer among Filipinos, despite it being one of the most treatable and preventable cancers. Colorectal cancer screening has been shown to reduce the risk of death by around 70%. The massive worldwide campaign for colorectal cancer screening has its beginnings in the United States in 2000.

How to Diagnose Colon Cancer?

In several countries, CRC screening is recommended for people starting the age of 50 years. Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colorectal cancer, and in those with other additional risk factors. Currently in the United States, a recommendation to start screening the average-risk patients earlier at the age of 45 due to increasing incidence of colorectal cancer in younger individuals. The death of “Black Panther” star Chadwick Boseman last year brought the spotlight on colorectal cancer, when he died at a young age of 43.

The gold standard test for colon cancer is a colonoscopy as it can detect and remove pre-cancerous polyps. The procedure involves a flexible fiber-optic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia.

Some patients may not want to have an invasive test. A stool test called FIT is a good alternative screening test for colon cancer. It detects only human blood and is specific for bleeding in the colon. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer. In pandemic times, the FIT test may be used to stratify patients as to who need the colonoscopy more urgently than others, given the more limited health resources of our country during these times.

What are the Risk Factors Associated with Colon Cancer?

Almost all of the types colorectal cancers start as abnormal growths in the lining of the colon and rectum called polyps. These polyps grow slowly and may take around 10 years for some polyps to develop into cancer. However, not all polyps progress to cancer. The removal of these polyps reduces the risk of developing cancer.

These polyps and early cancer may not cause complaints, like rectal bleeding, constipation, and abdominal pain that are experienced by patients in later stages of cancer.

The most common individual-specific factors that increase risk for cancer in the colon and rectum are:

• Age greater than 50
• Personal history of colorectal cancer or advanced polyps
• Family history of cancer in the colon and rectum
• Certain diseases, like Inflammatory Bowel Disease

Being older than 50 years old is the most common risk factor for this cancer, as 90% of these occur after the age of 50. A family history of a first-degree relative with CRC is increased two to three-fold.

There are also lifestyle habits that can be modified that likely contribute to the formation of this cancer:

• Cigarette smoking
• Alcohol consumption
• Obesity
• Lack of exercise
• A diet that has high saturated fat, low fiber, and high red meat consumption

Living a healthy lifestyle by avoiding smoking, not consuming excessive alcohol, regular exercise, and eating the right food all can lower your risk of cancer in the colon and rectum.

How Do I Know If I Need to Be Tested?

If you are experiencing any symptoms such as changes in bowel habits, blood in the stool, abdominal pain or discomfort, unexplained weight loss, or fatigue, it's important to consult a doctor for further evaluation. Additionally, if you have any risk factors mentioned above, it's recommended to discuss with your doctor about when and how often you should undergo screenings.

How Often Should I Get Tested?

The frequency of screenings can vary depending on individual risk factors and test results. It's important to discuss with your doctor about a personalized colon cancer screening plan. In general, individuals at average risk should undergo a colonoscopy every 10 years, while those with increased risk may need more frequent screenings.

This fight against the world’s second deadliest cancer is an uphill battle in the Philippines. The lack of a national population-based CRC screening program and the big financial burden of CRC screening on the patient are barriers to this campaign. In addition, several local health maintenance organizations (HMOs) still refuse to pay for CRC screening strategies. There is also an apparent lack of awareness among the primary health providers of the screening guidelines for colorectal cancer screening.

In the Philippines, The Medical City and its doctors have been among the leading advocates for this cause since 2010, initiated by noted colorectal surgeon Dr. Manuel Francisco T. Roxas. The Medical City has been among the first institutions in the Philippines to champion this advocacy, as it continues to be at the forefront in the fight against colorectal cancer (CRC) for more than 10 years.

If you or a loved one is at risk for colorectal cancer, don't wait until it's too late. Speak to your doctor or head to a colorectal cancer clinic about getting screened and take control of your health today. Remember, early detection can save lives. Let us work together towards a healthier Philippines, one screening at a time.